HomeMy WebLinkAboutContract 58860-FP1FORTWORTH,
PARK & RECREATION DEPARTMENT
NOTICE OF PROJECT COMPLETION
-FP1
City Secretary No. 58860
Date Received: 1/29/2025
City Project N!?: 102353
Regarding contract 58860 Playground Replacement at 7 Parks North for as required by the PARK &
RECREATION DEPARTMENT as approved by City Council on 12/13/2022 through M&C 22-1033 the
director of the PARK & RECREATION DEPARTMENT upon the recommendation of the Assistant Director
of the Park & Recreation Department has accepted the project as complete.
Original Contract Prices:
Amount of Approved Change Orders:
Revised Contract Amount:
Total Cost Work Completed:
Less Deductions:
Liquidated Damages:
Pavement Deficiencies:
Total Deduction Amount:
Total Cost Work Completed:
Less Previous Payments:
Final Payment Due
Recommended for Acceptance Asst. Director,
PARK & RECREATION DEPARTMENT
Accepted
Director, PARK & RECREATION DEPARTMENT
C) •• ' - -- - - -- - -
Asst. City Manager
Comments:
$ 1,972,007.80
$ 135,055.12 2V9 2
$ 2,107,062.92
$ 2,107,062.92
Days @ $650.00/ Day
$ 2,107,062.92
$ 2,001,709.77
$ 105,353.15
Jan 22, 2025
Date
Jan 23, 2025
Date
Jan 28, 2025 _
Date
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
C-620 Signature Page
Contractor's Application for Payment
To (Owner) City of Fort Worth Invoicing Period (From- To):
P. G:
Number: FW080-0000011515
Project: 102353
City Secretary Contract
Number:
Approved Change Orders
Number
1
2
3
4
5
6
7
8
TOTALS
NET CHANGE BY
CHANGE ORDERS
Contractor's Certification
58860
Application For Payment
Change Order Summary
Additions
$132,169.22
$39,041.75
$171,210.97
Invoice No.#10 Retainage
Invoice Date:
From (Contractor): Remit to ( If Not Automatic Deposit ):
L J DESIGN & CONSTRUCTION LLC
Contractor's CFW Vendor No.:
0000035512
Contract Playground Replacement at 7 Park Sites: Arcadia Trail, Arcadia Trail South, Eugene McCray,
Name: Littlejohn, Marine, Quanah Parker and Wright -Tarlton Parks
$135,055.12
1. ORIGINAL CONTRACT PRICE..........................................................
$ $1,972,007.80
Deletions 2. Net change by Change Orders.................................................................
$ $135,055.12
$36,155.85 3. Current Contract Price (Line 1 f 2)........................................................
$ $2,107,062.92
4. TOTAL COMPLETED AND STORED TO DATE
(Progress Estimate, Construction Allowance and Change Orders).......
$ $2,107,062.92
5. RETAINAGE:
a. X $2,107,062.92 Work Completed..........
$
b. X Not Used
$
c. Total Retainage (Line 5a + Line 5b) ...............................
$
6. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c).............................
$ $2,107,062.92
$36,155.85 7. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)........
$ $2,001,709.77
8. AMOUNT DUE THIS APPLICATION .................................................
$ $105,353.15
9. BALANCE TO FINISH, PLUS RETAINAGE
(Column G on Progress Estimate+ CA + Cos + Line 5 above) ..............
$ $0.00
The Contractor certifies with the submittal of this document and associated Payment Request Submittal
on the City of Fort Worth Buzzsaw system that to the best of their knowledge: (1) all previous progress
payments received from Owner on account of Work done under the Contract have been applied on
account to discharge Contractor's legitimate obligations incurred in connection with Work covered by
prior Applications for Payment (2) title of all Work, materials and equipment incorporated in said Work
or otherwise listed in or covered by this Application for Payment will pass to Owner at time of payment
free and clear of all Liens, security interests and encumbrances (except such as are covered by a Bond
acceptable to Owner indemnifying Owner against any such Liens, security interest or encumbrances);
and (3) all Work covered by this Application for Payment is in accordance with the Contract Documents
and is not defective.
Liquidated Damages $650.00 x day
PUDOGfP�y
Greg Woo ey (Jan 17, 2025 7:57 CST)
10. CONTRACT TIME:
a, Days Awarded 200
b, Days Added by CO
C. Total Days 200
d, Days Charged 200
e, Days Remaining
Consent of Surety
Affidavit of Bills Paid
This document has been modified from its original form as an EJCDC document and the user did not highlight the
modifications. You are encouraged to read the document carefully and consult Legal Counsel prior to its execution.
CSC No. 58860-0O2
F0R'rW6R'1'H,: City of Fort Worth
Change Order Request
Project Name Playground Replacement at 7 Parks North I
City Sec It I 58860 l
Client Project 11(s)l 102353
l
Project Descdplionl
Playground replacements at Arcadia Trail, Arcadia Trail South, Eugene McCray, Littlejohn, Marine, Quanah
Parker, Wright -Tarlton Parks
Conlraclorl L.J. Design & Construction Change Order#1 2 I
Dalel 2/1312024
City Project Mgr. Patrick Vicknair City Inspectorl
Byron McDonald l
Dept. PARD
Contract Time
Totals (CD�
Original Contract Amount $1,972,007.80
$1,972,007.80 00
Extras to Date $96,013.37
$96,013.37
Credits to Date
Pending Change Orders (in M&C Process)
Contract Cost to Date $2,068,021.17
$2,068,021.17 200
'Go to ADD & DEL Tabs to Enter CO Backup $39,041.75
$39,041.75
Revised Contract Amount 2,107,062.92
$2,107,062.92 200
Original Funds Available for Change Orders 197,200.78
$197,200.78
Remaining Funds Available for this CO $101,187.41
$101,187.41
Additional Funding (if necessary)
CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT
6.85%
MAXALLOWABLECONTRACT AMOUNT (ORIGINAL CONTRACT COST+25%)
$2,465,009.75
JUSTIFICATION (REASONS) FOR CHANGE ORDER
This change order is for additions requested by the owner during construction that include: design modifications, park amenities, grading, drainage and hydromulch.
It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment In full
(both time and money) for all costs arising out of, or incidental to, the above Change Order. The Project/Program Manager signing below acknowledges that
he/she is the person responsible for the monitoring and administration of this contract, Including ensuring all performance and reporting requirements.
Contractor's Company Name I
Contractor (Name) I Signature
I Date
l L.J. Design and Construction
Greg Woolsey : gapH retract
Jun zo, 2024 I
InspeclorMspecBon Supervisor
Date Project and Contract Compliance Manager
Date
�•,xw•au
Jun 21,2024 ���
Jun 21,2024
Program Manager
Dale \Senior Capital Project Officer
Dale
Jun 21, 2024 --/1—
Jun 24, 2024
Assistant Director Depl)
Date Director, Contracting Department (Dept)
Date .r
Jun 25,2024 °°' �
Jun 25, 2024
Assistant City Attorney
Dale rAssisianl City Manager
Date qM
Jun 27,2024 r
Jul2,2024
Council Action (if required)
A
M&C Number 1 24-0521 l M&C Date Approved
l 6/11/2024
ATTEST:
r...— A .1Sa2w KC
Jannette Goodall, City Secretary
Form WORTI City of Fort Worth
Change Order Additions
Project Name I Playground Replacement at 7 Parks North I City Sec ff 1 58860 1
Client Project it 1 102353 1
Contractorl L.J. Design & Construction PMl PatdckVicknalr I Inspector[ Byron klcDonald
Change Order Submittal 02 Date 2/1372024
AD91TIONS
1 IILM DLSCRIPIION
DEPI
City
Unit
UnitCost
total
1 Unit 3 - Eugene Mc(7ay Park
Add tion of h ding a[
Ich�na
nt to rarea
1 Addition of (emroma
olrmto establish grass in damaged
PARD
1.00W000U
LS
$10,404 OU
$10,404.001
Addition of Ihr€e coo Iv ith concrete plaza and ADA access
PARD
1.00000000
LS
$10,549.00
$10,549.g0'
Unit 6 - Quannah Parker Park
I
Additional excavation required fordrainage oulfall to river
PARD
�Q.�
LS59.QO--$450:001
Added concrete oulfall to river
PARD
1=26
LS
$25U.U0
$25�00
Unit 4-1.1111 ohnPark
AdditionalrefoCallonofproposed walk
PARD
1.00000000
LS
$3,000.00
$3,0W.00
Additional demolition of exis0�gQ retaini wa'J
PARD
1.O0W000U
LS
$150.00
$750.W
Additional dirt and grading [a Y entr nce
PARD
1.O0W00W
LS
1y900.06
t'630.OU
$900.00
Addition of new concrete curb and gutter (orADAramp
PARD
1.W0W000
LS
S630.001
AddiOonaldemohlgnoI oodppoosI
PARD
1.000W00U
LS
$$100.0U
1W.001
Addition alromovalofexistingda ds
PARD
1.0WW000
LS
5A59.99
�450.001
Unit 2 - Arcadia Trail Park South
Addition of a check valve on drainage pipe at oulfall
PARD
1.00000000
LS
$195.75
$195.751
Unit i -Arcadia Trail Park
Additional grading and did to raise existing cookerlonew elevation
PARD
1.1100000ou
LS
$150.W
$15U.00
Additional bermuda sod In area of relocated sidewalk
PARD
1.00000000
LS
$8,000.W
$8.000.00
I
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I
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I
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I
I
I
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I
II
i
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I
1
1
I
1
1
I
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I
1
1
1
PARD $39.041.751
I
I
I
Sub Total Additions $39,041.751
Change Order Additions Page 2 of 4
MISBE for this Change Order
MISBE Sub Type of Service Amount for this CO
Total $0.00
Previous Change Orders
Co # DATE AMOUNT
Total $0.00
6114/24, 1:43 PM
CITY (COUNCIL /AGENDA
Create New rrom This M&C
M&C Review
Official site of the City of Poet Worth, texas
FORT 1NORTI I
REFERENCE **M&C 24- 80 PLAYGROUND
DATE: 6/11/2024 NO.: 0521 LOG NAME: REPLACEMENTS AT 7 PARKS
NORTH
CODE: C TYPE: CONSENT PUBLIC NO
HEARING:
SUBJECT: (CD 2, CD 4, CD 5, CD 7 and CD 11) Authorize the Execution of Change Order No. 2 to
City Secretary Contract No. 58860, in the Arnount of $39,041.75, with L.J. Design &
Construction, LLC, for the FY20 Playgrounds (North) Project for a Total Construction
Contract Arnount of $2,107,062.92
RECOMMENDATION:
It is recommended that the City Council authorize the execution of Change Order No. 2 to City
Secretary Contract No. 58860, in the amount of $39,041.75, with L.J. Design & Construction, LLC, for
the FY20 Playgrounds (North) project (City Project No. 102353) for a total construction contract
amount of $2,107,062.92.
DISCUSSION:
The purpose of this Mayor and Council Communication (M&C) is to authorize the execution of Change
Order No. 2 to City Secretary Contract No. 58860, in the amount of $39,041.75, with L.J. Design &
Construction, LLC, for the FY20 Playgrounds (North) project (City Project No. 102353) for a total
construction contract amount of $2,107,062.92.
On December 13, 2022 (M&C 22-1033), City Council authorized the execution of a construction
contract with L. J. Design & Construction, LLC, in the amount of $1,972,007.80 for construction of
seven playground replacements at the following parks: Arcadia Trail, Arcadia Trail South, Eugene
McCray, Littlejohn, Marine, Quanah Parker, and Wright -Tarlton. After the award of construction, it was
determined that changes were needed to address as built quantities verses bid quantities. Change
Order No. 1, was executed administratively on March 11, 2024 for $96,013.37 to address those
changes. Change Order No. 2 includes accommodations for design modifications, additional park
amenities, grading, drainage, and hydro mulch. No additional days are requested with this change
order request.
Original Construction Contract $ 1,972 007.80
Change Order No. 1 $ 96,013.37
------------- ---- - - - - - - - -- -- --
Change Order No. 2 I $ 3-9,041.75
Total Construction Contract $ 2,107,062.92
Funding is budgeted in the PARD Gas Lease Capital Projects Fund for the purpose of funding the
FY20 Playgrounds (North) project, as appropriated.
L. J. Design & Construction, LLC, agrees to maintain its initial M/WBE commitment of 5\% that it made
on the original contract and extend and maintain that same M/WBE commitment of 5\% to all prior
change orders up to and inclusive of this Change Order No. 2. Therefore L. J. Design & Construction,
LLC, remains in compliance with the City's M/WBE Ordinance and attests to its commitment by its
signature on the Acceptance of Previous M/WBE Commitment form executed by an authorized
representative of its company.
The seven playground replacements are located in COUNCIL DISTRICTS 2, 4, 5, 7, 11.
FISCAL INFORMATION/CERTIFICATION:
tile:///X:/PLANNING & RESOURCE MANAGEMENT/CAPITAL PROJECTS INFRASTRUCTUREIPROJECTS_ACTIVE/PV - Playground Replacement,.. 112
Gh4/24. A3 PM M&C Review
The Director of Finance certifies that funds are available in the current capital budget, as previously
appropriated, in the PARD Gas Lease Capital Projects Fund for the FY20 Playgrounds (North)
project to support the approval of the above recommendation and execution of the change order. Prior
to an expenditure being incurred, the Park & Recreation Department has the responsibility of verifying
the availability of funds.
TO
Fund Department Account Project Program Activity Budget Reference it Amount
ID I I ID I I I Year I (Chartfield 2)
FROM
Fund Department Account Project I Program Activity I Budget I Reference # I Amount
ID ID Year (Chartfield 2)
Submitted for Citv Manaaer's Office bv:
Originating Department Head:
Additional Information Contact:
Jesica L. McEachern (5804)
Richard Zavala (5704)
Scott Penn (5750)
ATTACHMENTS
80 PLAYGROUND REPLACEMENTS AT 7 PARKS NORTH funds availabililv.pdf (CFW Internal)
80 Plavaround renlacements at 7 Parks North.xlsx (CFW Internal)
L J Acceptance of Previous MWBE Committment Slaned RL.ndf (CFW Internal)
LJ Desian and Construction CO #2.pdf (CFW Internal)
LJ Form 1295.pdf (CFW Internal)
file:MX:IPLANNING & RESOURCE MANAGEMENT/CAPITAL PROJECTS INFRASTRUCTURE/PROJECTS_ACTIVE/PV - Playground Replacement... 2/2
CSC No. 58860-Col
FoR�r
Project Namel Playground Replacement at 7 Park Sles
Client Project #(s)l 102353
Project Description
Contractor)
City Protect Mgr.1
City of Fort Worth
Change Order Request
I City Sec # 1 58860
Playground replacements at Arcadia Trail, Arcadia Trail South, Eugene McCroy, Littlejohn, Marine, Ouanna Parker, Wright -Tarlton Parks
L.J. Design & Construction
Patrick Vicknair
Dept.
Orglnal Contract Amount
Extras to Date
Credits to Date
Pending Change Orders (in M&C Process)
Contrad Cost to Date
'Go to ADD g DEL Tabs to Enter CO Backup
Revised Contract Amount
Original Funds Available for Change Orders
Remaining Funds Available for this CO
Additional Funding (if necessary)
PARD
$1,972.007,80
Change Order #1 1 I Datel 229024
City Insce,-tor1 Byron McDonald
Contract Time
Totals (CD
$1,972.007.80 �2io
$1,972,007.00
$1,972,007.80 200
96,013.37
126013.37
$2,068,021.1
$2X8,0`11.17 200
$197 200.7
197,200-78
1197,200.78
ty6a/d
I
CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 4,87%
btAXALLONJABLECOIJTRACTAIAOUNT(ORIGINAL CONTRACTCOST+ 25%) 52,465,009-75
JUSTIFICATION (REASONS) FOR CHANGE ORDER
This change order is for adjustments to the quantibes bid by Die contractor per the construction documents verses ttie quint t es measured dur no cor,st•uctlon and at substainat
completion and per the as built drawings.
It Is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in full
(both time and money) for all costs arising out of, or incidental to, the above Change Order, The Project/program Manager signing below acknowledges that
he/she is the person responsible for the monitoring and administration of this contract, Including ensuring all performance and reporting requirements.
Contractor's an
L J Design and Construction
!nspectorAnsomilion S
tractor Name
Graq Wcolsey
Date
Mar 4, 2024
GvGr i'rtltc�'
ct and ConWd Compliance Manager
%,`- .i..__
t?aN
\tar 1, 2024
Date
!.1ar4, Tula
Prograll
Date
Senior Capital cIOfficer
Date
Mars, 2024
Mar 5, 2024
Ass
. ,..i'
Date
Director, Contracting Department (Depq w
Date
Filar 7, 2024
� — - ------
Mar 7, 70; •�
AasblaM Atkin
Date
Assistant City l0an.r er
Dale
t•.1dr q, Jt1)4
I
Mar 11. 2024
CouncilActien(if required)
M&C Number 1 22.1033 M&C Date Approved
1 12/1120221
ATTEST:
Jannette Goodall, City Secretary
ForcrWoen'n City of Fort Worth
Cliange Order Deletions
Project Name I Playground Replacement all Parks North I City Sec It 1 58860 1
Client Project 1 1 102353 1
Contractorl L.J. Design 8 Construction PMI Patrick Vcknai I Inspeclorl Byron McDonald
Change Order Submittal 11 0 Dale 2l131202A
UE _EIIUNS
UESCHIPIIUN - DEPI city Unit ' Unit Cost total
I
I
I I
I I
PARD $0.001
I
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I
Sub Iolal Uelebons $0.001
Change Order Deletions Page 3 of A
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
December 9, 2024
L.J. Design & Construction, LLC
658 Peden Rd.
Fort Worth, TX. 76179
RE: Acceptance Letter
Project Name: Playground Replacement at 7 Parks
Project Type: Paving, Playground
City Project No.: 102353
To Whom It May Concern:
On October 25, 2023 a final inspection was made on the subject project. There were punch list items
identified at that time. The punch list items were completed on November 30, 2023. The final
inspection and the corrected punch list items indicate that the work meets the City of Fort Worth
specifications and is therefore accepted by the City. The warranty period will start on November 30,
2023, which is the date of the punch list completion and will extend of two (2) years in accordance with
the Contract Documents.
If you have any questions concerning this letter of acceptance, please feel free to contact me at 682-
329-6637.
Sincerely,
Pates d�c,e%a�,
Patrick Vicknair, Project Manager
Cc: Byron McDonald, Inspector
Gary Deyon, Inspection Supervisor
Edward D'avila, Senior Inspector
Jing Yang, Program Manager
Pacheco Koch, Consultant
L. J. Design & Costruction, Contractor
City of Fort Worth, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Before & After Pictures
Financial Documents
Rev. 8/20/19
CONSENT OF
OWNER
■
SURETY COMPANY
ARCHITECT
❑
TO FINAL PAYMENT
CONTRACTOR
❑
AL4 DOCUMENT G707
SURETY
❑
OTHER
❑ Bond # 4459612
PROJECT: Playground Replacement at Arcadia Trail, Arcadia Trail South, Eugene McCray, Littlejohn, Marine,
Quanah Parker, and Wright -Tarlton Park, 30100-0800450-5330500-102353-004880-999
(name, address)
TO (Owner) City of Fort Worth
200 Texas Street
Fort Worth, TX 76102
CONTRACTOR: L.J. Design & Construction, LLC
ARCHITECT'S PROJECT NO:
CONTRACT FOR:
CONTRACT DATE: December 13, 2022
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(here insert name and address of Surety Comjpany)
SureTec Insurance Company
2103 CityWest Blvd., Suite 1300
Houston, TX 77042
on bond of
(here insert name and address of Contractor)
L.J. Design & Construction, LLC
9176 Hyde Rd.
Fort Worth, TX 76179
.SURETY COMPANY.
,CONTRACTOR.
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall
not relieve the Surety company of any of its obligations to
(here insert name and address of Owner)
City of Fort Worth
200 Texas Street
Fort Worth, TX 76102
,OWNER,
as set forth in the said Surety Company's bond
IN WITNESS WHEROF,
The Surety Company has hereunto set its hand this Sth day of January, 2025
Attest
(seal):
SureTec Insurance Company
Surety Company
Signature of rized Re entative
Title Jeremv Barnett, Attorney -in -Fact
NOTE This romi is to be used as a companion dOCLlnlent to AIA DOCUMENT G706. CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBT AND CLAIMS,
Current Edition
AIA DOCUMENT G707 * CONSENT OF SURETY COMPANY TO FINAL PAYMENT *APRIL 1970 EDITION *AIA
POA# 4221941
JOINT LIMITED POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That SureTec Insurance Company, a Corporation duly organized and existing under the laws of the State of Texas and having its
principal office in the County of Harris, Texas and Markel Insurance Company (the "Company"), a corporation duly organized and existing under the laws of the state
of Illinois, and having its principal administrative office In Glen Allen, Virginia, does by these presents make, constitute and appoint:
Tony Fierro, Jay Jordan, Johnny Moss, Steven W. Searcey, Robert J. Shuya, Jeremy Barnett, Robert G. Kanuth,
Jade Porter, Jennifer Cisneros, Jarrett Willson, Jack Nottingham, Brady Wilson, Brennan Williamson, Jarod Jaggers,
Caleb Hale, Ryan Cox
Their true and lawful agent(s) and attorney(s)-in-fact, each in their separate capacity if more than one is named above, to make, execute, seal and deliver for and on
their own behalf, individually as a surety or jointly, as co -sureties, and as their act and deed any and all bonds and other undertaking in suretyship provided, however,
that the penal sum of any one such instrument executed hereunder shall not exceed the sum of:
Twenty Million and 00/100 Dollars ($20,000,000.00)
This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolutions adopted by the Board of Directors of SureTec
Insurance Company and Markel Insurance Company:
'RESOLVED, That the President, any Senior Vice President, Vice President, Assistant Vice President, Secretary, Assistant Secretary, Treasurer or Assistant Treasurer
and each of them hereby is authorized to execute powers of attorney, and such authority can be executed by use of facsimile signature, which may be attested or
acknowledged by any officer or attorney, of the company, qualifying the attorney or attorneys named ill the given power of attorney, to execute in behalf of, and
acknowledge as the act and deed of the SureTec Insurance Company and Markel Insurance Company, as the case may be, all bond undertakings and contracts of
suretyship, and to affix the corporate seal thereto.'
IN WITNESS WHEREOF, Markel Insurance Company and SureTec Insurance Company have caused their official seal to be hereunto affixed and these presents to be
sighed by their duly authorized officers on the 11th day of September , 2024 -
SureTec Insurance Company
SUFtANC�
UJI .*Uv A
Michael C. Keimig, kesident
State of Texas
County of Harris:
.•�aU+NcF Markel I�tsUrance Company
Syl
L4YJennings, %ice President
On this 11th day of September , 2024 A. D., before me, a Notary Public of the State of Texas, in and for the County of Harris, duly commissioned and qualified,
came THE ABOVE OFFICERS OF THE COMPANIES, to me personally known to be the individuals and officers described in, who executed the preceding instrument, and
they acknowledged the execution of same, and being by me duly sworn, disposed and said that they are the officers of the said companies aforesaid, and that the
seals affixed to the proceeding instrument are the Corporate Seals of said Companies, and the said Corporate Seals and their signatures as officers were duly affixed
and subscribed to the said instrument by the authority and direction of the said companies, and that Resolutions adopted by the Board of Directors of said Companies
referred to in the preceding instrument is now in force.
•asattrtrttrrlr'
IN TESTIMONY WHEREOF, I have hereunto set my hand, and affixed my Off;;ii VS,e e QHarris, the day and year first above written.
By:
n SI _ Chelsea Turner, Notary Public
.' My commission expires 7/6/2028
4�7 OFWe, the undersigned Officers of5ureTec Insurance Company and Markel Insty Cvrtrpa dq JZR� Acertifythat the original POWER OF ATTORNEY of which the
foregoing is a full, true and correct copy is still in full force and effect and has neip'eegi •a
a
'1��,��,essala
IN WITNESS WHEREOF, we have hereunto set our hands, and affixed the Seals of said Companies, on the 8th day of January 2025
SureTec Insurance Company l,ys� Markel Insurance Company
7 ! B
.tom
M. Brent Beaty, Assistant Secretary 9ndrew Marquis, Assistan.�ecretary
Any Instrument Issued in excess of the penalty stated above is totally void and without any validity. 4221941 !f!f
For verification of the authority of this Power you may call (713)812-0800 on any business day between-8:30 AM and S:00 PM CST.
AFFIDAVIT
STATE OF Texas
COUNTY OF Tarrant
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Greg Woolsey,
Owner Of L. J. Design & Construction LLC, known to me to be a credible
person, who being by me duly sworn, upon his oath deposed and said;
That all persons, firms, associations, corporations, or other
organizations furnishing labor and/or materials have been paid in full;
That the wage scale established by the City Council in the City of
Fort Worth has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
Playground Replacement at 7 Parks South
BY
Gri Woolsey, Owner
Subscribed and sworn before me on this date 8th of January, 2025.
6?M"A—)
Notary Public
County, State
`ra rran41 Tefas
BONNIE FLORES
�rtvP�a`s
=Notary Public, Stets of Texas
Comm. Expires 07-1r-2025
Notary 1D 124313796
a
Arcadia Park Playground # 7 — BEFORE
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Arcadia Park Playground # 7 — AFTER
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t F
.wr
um of Amc
Fund
3010
100 Total
2060000 102353 RETAIN (48,615.10)I (78,600.35)
(48,615.10) (78,600.35)
(48,615.10) I (78,600.35)
A B
C I D
I E
I F
G
H I J
K
L M
I
2 Sum of Amount
Column Labels
3 Fund Journal
D.
••
4
4/24/2023
2060000
104574
RETAIN
(9,053.14)
5
5/23/2023
2060000
104574
RETAIN
(3,299.39)
6
6/13/2023
2060000
104574
RETAIN
(3,092.04)
7
8/18/2023
2060000
104574
RETAIN
(1,821.65)
8
8/24/2023
2060000
104574
RETAIN
(982.07)
9
9/28/2023
2060000
104574
RETAIN
(631.08)
10
10/1/2023
2060000
104574
RETAIN
(18,879.37)
11
11/28/2023
2060000
104574
RETAIN
(295.78)
12
12/19/2023
2060000
104574
RETAIN
(795.20)
13
10/29/2024
2060000
104574
RETAIN
(6,782.46)
14
(18,879.37)
(19,970.35)
(6,782.46)
15 Grand Total
(18,879.37)
(19,970.35)
(6,782.46)
16